1029-02 NURS7125 – Older Adults’ Health

NURS7125 – PresentationAssessment Overview:
This assessment item is a presentation exploring the Australian National Safety and Quality Health Service Standards
(NSQHS) and how these relate to the care of older adults. The NSQHS provide a consistent statement on the level of
care that consumers can expect from a Health Service. There are currently eight (8) NSQHS, additionally, a Sepsis
Clinical Care Standard has recently been launched.
Course learning objectives related to this assessment item
1.
2.
3.
Examine common health conditions and issues related to older adulthood and identify strategies to implement
person centred care across a range of healthcare settings
Explore and critique nursing roles and inter-professional roles and relationships within health and community
care settings used by older adults
Demonstrate cultural responsiveness when working with older adults from Aboriginal and Torres Strait
communities and culturally and linguistically diverse (CALD) backgrounds, including older adults from lesbian,
gay, bisexual, transsexual and intersex communities
In preparation for the assessment:
•
Access the Australian Commission on Safety and Quality in Health Care on:
https://www.safetyandquality.gov.au/standards/nsqhs-standards and study the NSQHS.
•
Attendance at lectures and tutorials plus working steadily through the Blackboard modules for week 1-12 will
position students well to succeed in this assessment
•
Read the clinical scenario provided.
Clinical scenario
Mrs Kale is an eighty (80) year old Torres Strait Islander woman admitted to the acute medical ward with left sided
hemiparesis post a Cerebrovascular Accident (CVA). Mrs Kale’s medical history includes Insulin Dependent Diabetes
Mellitus, Depression and Congestive Cardiac Failure. The treatment plan for Mrs Kale is to treat the CVA conservatively.
The estimated duration of admission in the acute medical ward is seven (7) days.
Your presentation:
•
Provide an overview of two (2) NSQHS Standards relevant to the care of Mrs Kale during her admission.
•
Critically describe how the identified NSQHS Standards support safety and quality in the care of Mrs Kale for the
duration of her admission. Your response should demonstrate a person-centred, culturally safe and
comprehensive approach to the care of Mrs Kale.
•
Your presentation is recorded using Voice Over PowerPoint (or similar software) and the recording is uploaded to
Blackboard
CRICOS Provider 00025B
1
•
Your presentation must be of 10 minutes duration. More than 10% under or over the time limit will be penalised
10% as per NMSW Assessment Guidelines.
•
As with all academic submissions, all sources must be accurately cited. Referencing style for the power point
presentation is Vancouver.
Submission details:
Submission of a voice- over power point presentation version via Turnitin
Time: 13:00
Date: 28th October (Week 13)
Feedback:
Written feedback on the presentation will be made available to students via Turnitin
CRICOS Provider 00025B
2
Older Adults’ Health
Communication, Assessment, Care
Planning and the
Older Adult.
Susan Nunan. (2022)
Clinical Academic: Course Coordinator:
UQ School of Nursing Midwifery
and Social Work.
Copyright Notice
This material is for the exclusive use of students and staff of the University of Queensland
and should not be reproduced for any other purpose.
Do not remove this notice.
Lecture Objectives
❖This lecture will:
❖Overview person-centred care and the Older Adult.
❖Explore and discuss effective interpersonal communication with Older
Adults.
❖Outline and explore the person-centred biographical approach to
assessment and care planning for the Older Adult.
Person-centred Care and
the Older Adult
➢What is person-centred care?
➢Think / pair / share
➢Nurses support not only physical needs, but also social, emotional and personal
beliefs.
➢Widely recognised as best practice.
➢Particularly in relation to caring for older people.
➢Follows holistic approach to care.
➢Challenge for nurses.
➢How to best care for diverse older people.
There is no “typical” Older
Person
The VIPs – Main Concepts of PersonCentred Care
➢V : stands for?
➢Value- value of all human beings.
➢I : stands for ?
➢ Individualised approach.
➢ P : stands for?
➢ Personhood- understanding the world from the perspective of the person.
➢ S : stands for?
➢Social- encouraging a social environment.
Person-Centred Care/ Culture &
Diversity
➢Culture: Beliefs and ideas of a certain group of people
➢Important to create a culturally safe environment
➢Term ethnicity can also be linked to culture
➢In Australia, cultural considerations for Indigenous Australians (First Australians)
➢And people from Multi-cultural community (CALD background)
➢Diversity relates to differences and combinations.
Effective interpersonal communication
and the Older Adult
➢What are some enablers of effective communication with Older Adults.
➢ go to: https://apps.elearning.uq.edu.au/wordcloud/94211
➢ Respectful Communication
➢ Highlighting human worth
➢ Positive perception of the older person
➢ Avoiding stereotypes.
➢Improving self-identity and minimising vulnerability
➢ Use the client’s name
➢ Speak “with” and not “at” the client
➢ Language that the client understands
➢Culturally safe language
➢Listen attentively
➢Empathetic engagement with the older person.
Effective interpersonal communication
and the Older Adult
➢What are some barriers to effective communication with Older Adults.
➢ go to: https://apps.elearning.uq.edu.au/wordcloud/94211
➢ Depersonalisation
➢ Humiliation
➢ Invisibility of older person
➢ Lack of Voice of older person
➢ Not listening attentively
➢ Patronising attitudes
➢ Ageist attitudes and stereotypes
➢ Lack of respect
The Person-centred Biographical Approach
to Assessment and Care Planning.
➢Strategic approach to help involve older person in assessment and care planning.
➢Underpinning factors to this approach:
➢ Support for the nurse
➢ Eliciting significant details
➢ Fostering communication strategies
➢ Developing responsive relationships
Biographical Approach to Assessment
and Care Planning
➢A biographical approach to health assessment and care planning is a person-centred approach to care
that goes beyond assessing and caring for a person’s physical and psychological needs to find out more
about the older person’s everyday life experiences, their aspirations concerns and relationships and to
find out what is important to them. This approach is ongoing and as you come to know the older person
through listening to their stories, you gain a better appreciation of their needs and what you can do to
assist in their well-being.
➢The following reading describes a structured a biographical approach to health assessment and care
planning for the older adult. You will need to be signed into the library to access the readings.
➢Brown Wilson, C. (2013) Caring for Older People: A Shared Approach. London, Sage Publications Read
Chapter 6. You may also wish to read Chapter 3 of this book, which gives a background to the personcentred care for the older adult which underpins the biographical approach.
Caring for older people: a shared approach
Assessment Process
➢Finding out what matters.
➢Case Study:
➢Jane Davidson 75 yrs old, is admitted to hospital with acute abdominal pain for
investigation.
➢What are some examples of questions that you could ask Jane to find out what
matters to her which may affect your care planning and her stay in the hospital?
➢ https://padlet.com/uqsue/Assess
Assessment process.
➢Some examples.
➢What would you like staff to call you?
➢Who are the people closest to you and who do you want us to communicate with?
➢What is your understanding of why you are in hospital?
➢Do you have anything worrying you in particular at the moment about your hospital
stay?
➢What is important for you while you are in hospital?
➢Would you like to speak to someone in particular?
Assessment and Care Planning:
Roper et al’s (2001) activities of living (ALs) or (ADLs)
Assessing and Care Planning
➢Using biographical information to explore the abilities of a person before they
required the care that they now need.
➢This information supports the nurse in understanding client’s immediate needs.
➢Helps also to consider future goals.
➢Consider one example from the Activities of Daily Living table “Sleeping”
➢What kind of questions could you ask Jane to gather biographical information in your
assessment, and how might this affect your care planning for Jane while she is in
hospital.
➢https://padlet.com/uqsue/ADL
Assessing and Care Planning
➢A few examples could be:
➢What is her normal sleeping routine at home?
➢How many hours does she usually sleep each night?
➢Is there anything that disturbs her sleep or anything that she needs to sleep well (eg.
Hot milk before bed, sleeping tablet, listening to relaxing music on her ipad etc)?
➢How does the pain that she is experiencing now disturb her sleep?
➢Is there any worry or concern that may be preventing her from sleeping well?
➢Is there anything that she would need to help her to sleep well now that she is in
hospital.
➢Current pain assessment, care planning for pain relief, pharmaceutical and nonpharmaceutical.
Summary
❖A brief overview person-centred care and the Older Adult was provided
and explored.
❖Effective interpersonal communication with Older Adults was briefly
discussed and explored.
❖The person-centred biographical approach to assessment and care
planning for the Older Adult was briefly outlined and explored using a
case study.
Some References
➢Brown Wilson, C. (2013) Caring for Older People: A Shared Approach. London, Sage
Publications
➢Chenoweth, L., & Samuel, L., (2021). Considering the older person. In Crisp, J.,
Douglas, C., Rebeiro, G. Waters D. (Eds.) Potter & Perry’s Fundamentals of NursingAustralian and New Zealand Edition (6th ed) (pp. 1252-1290). Sydney, Australia:
Elsevier
➢Moyle, W. (2014) Principles of strengths-based care and other nursing models. In W.
Moyle, D. Parker & M. Bramble (Eds.), Care of Older Adults. A strengths-based
approach. (pp. 33-48) Melbourne: Cambridge University Press.
➢Yeboah, C. & Glass, N. (2017) Attitudes and communication: the older person, carers
and families. In Johnson, A. & Chang, E. (Ed.) Caring for older people in Australia, (2nd
ed). (pp. 80-108) Milton: John Wiley & Sons
Any Questions ???
NURS1104/7125
Susan Nunan. (2022)
Clinical Academic: Course Coordinator:
UQ School of Nursing Midwifery
and Social Work.
Copyright Notice
This material is for the exclusive use of students and staff of the University of Queensland
and should not be reproduced for any other purpose.
Do not remove this notice.
Acknowledgment of Country
The University of Queensland (UQ)
acknowledges the Traditional Owners and their
custodianship of the lands on which we meet.
We pay our respects to their Ancestors and
their descendants, who continue cultural and
spiritual connections to Country.
We recognise their valuable contributions to
Australian and global society.
3
Lecture Objectives
❖This lecture will:
❖Outline some of the major Theories of Ageing.
❖Discuss Ageism (in relation to the older person) and some of the
reasons for this in our society.
❖ Provide a particular overview of Ageism in the Mass Media.
❖ Negate some common Myths regarding the older person by presenting
facts.
❖Discuss how we as nurses and individuals in society can make a
difference in combatting ageism.
❖Discuss how ageism can lead to Elder Abuse.
❖Provide a brief overview of Elder Abuse, relevant laws in Australia and
an Elder Abuse support unit in Queensland.
Theories of Ageing.
➢ Knowledge and attitudes about ageing influence us.
➢ Historically ageing viewed in a negative way.
➢ Biological focus
➢ Perceptions based on illness and decline.
➢ More recently ageing is viewed more positively.
➢ Emphasis on healthy, positive and successful ageing.
➢ Maximise independence.
➢ Enhance quality of life (QoL)
➢ Health promotion and remaining in the community
where possible.
Theories of Ageing
➢ Historical perspectives provide context for theoretical
perspectives of ageing.
➢ Theoretical knowledge assists to identify the needs of
the older person.
Theories of Ageing
 What are some of the major categories of theories of
ageing?
 Biological
 Psychological
 Sociological.
Theories of Ageing.
Theories of Ageing
 No ageing theory on its own can address the individual
experience of ageing.
 Important to consider theories of ageing from all the
disciplines.
 Provide new insights to nursing body of knowledge in
gerontology.
Ageism.
❖What is ageism in relation to the older person?
❖Stereotypical attitudes and discriminatory prejudice
towards the older person in the form of Ageism is an
infringement of Human Rights.
❖ As a definition, ageism is similar to racism or sexism
as it discriminates against people based on stereotypes
of a particular group.
❖ Any apathy in favour of tolerating attitudes which
would be unacceptable in other age or cultural groups
mitigates the important principles within the human
rights agenda.
Ageism
❖ The specific Ageism which will be discussed in this
lecture is in relation to the older person.
❖Ageism, is a term which describes a profound
and deep prejudice against the older adult which exists
in Western societies.
❖ Research on ageism has a relatively short history
compared to other fields of prejudice research, with
the term ageism first being used to fit the concept by
Dr Robert Butler in 1969.
Ageism
❖ Ageism is a form of discrimination which is based
solely on a person’s age.
❖Therefore, ageism is a unique and strange form of
prejudice against the older us, as barring the
intervention of fate, all persons will grow old,…..
including us.
❖ Any attitudes or policies developed today will surely
affect us in our older years.
The Older Person in different
cultural contexts
❖ In contrast to ageist attitudes in some societies, many
traditional cultures hold the older person in high
esteem and give them great respect.
❖ In traditional Chinese culture there is a value of high
respect for the family and especially the older person.
❖ Respect for the older person was advocated by
Confucius, the famous Chinese philosopher.
The Older Person in different
cultural contexts
❖ Indigenous Australians traditionally respect the older
people or elders for their wisdom and knowledge.
❖ Older Indigenous Australians are greatly respected in
their family and hold important roles such as teachers,
cultural leaders and caretakers of the young.
The Older Person in different
cultural contexts
❖ In Vietnamese society older people are considered the
carriers of knowledge, wisdom and tradition.
❖ Age is considered as important and an asset to the
person rather than a liability.
❖ Older grandparents and parents remain in the family
and are supported and cared for.
Italian and
Greek Cultures
❖ In the Italian and Greek traditional cultures, the older
person is greatly respected and held in high esteem.
❖ Old age is seen as a very positive time in the life of a
person.
❖ The older person remains near or within the younger
family, taking an active role where possible and is
cared for by the extended family when necessary.
Reflective Practice
❖It is important as a nurse to reflect on your
beliefs and values regarding older people:
❖On reflection, what are your attitudes
with regard to ageing?
❖ What are your perceptions of your own ageing process
and of yourself as an older person?
❖Do you have any stereotypical views or prejudicial
attitudes towards the older person?
Ageism: Reflective Practice
❖Think / Pair / Share
❖How do you think that stereotypical and ageist views
have been promoted and accepted in our society?
❖ Why do you think some stereotypical views or
prejudicial attitudes have appeared in our society?
Ageism
❖ Australian society values youth in general.
❖ Reasons for ageism include:
❖ Social conditioning;
❖ media messages;
❖ social expectations;
❖ emphasis by society and governments on productivity;
❖ fear of one’s own ageing process and misinformation;
❖ myths and stereotypes of the older person.
Myths and
Stereotypes
❖ AGEISM IN THE MEDIA
❖Let’s explore some of the myths and stereotypes
regarding ageing and the older person, and why they
have developed in our society.
❖The Mass media plays a powerful role in society in
shaping attitudes towards different groups of people.
❖ Watch this video and take notes for discussion
afterwards, of any stereotypes and myths regarding the
older person used to provide comedy that you see here:
❖https://www.youtube.com/watch?v=O-5gjkh4r3g
Myths and
Stereotypes
❖ What did you find positive in this video ?
❖ What myths and stereotypes of the older person were
used to provide comedy in this inflight video?
❖http://padlet.com/uqsue/NMSW1
❖Post answers in above padlet link.
Myths and Stereotypes
❖ AGEISM IN THE MEDIA
❖Some good acting moments in this film trailer,
however, can you see any stereotypes related to ageing
used here in this comedy?
❖ https://www.youtube.com/watch?v=3MkcqIsraDU
https://padlet.com/uqsue/NMSW3
❖ Post your feedback using the above padlet link.
Ageism in Mass Media
❖ Gatling (2012) in her research on ageism in comedy
films, discusses this film ‘ Old Dogs’ in terms of it’s
ageist humour.
❖She points out that ageing is negatively represented in
this film, most frequently as impaired health, reliance
on medications, and decreased mobility.
❖ The aim of her research is not to be a ‘kill joy’ but
rather to highlight these ageist attitudes in comedy
films, so as to protect the older person and following
generations from ageist attitudes which can destroy
their self confidence.
Ageism in Mass Media
❖ Or birthday cards? Is ageism perpetuated here in the form
of humour?
❖ Do you think that our society accepts this form of ageism
under the guise of humour?
❖ Have you seen ageist humour used in greeting cards.
❖ Visit you local newsagents to see the many
examples of this type of ageist humour
used in cards.
❖ Do you think that the same
humour on cards would be accepted if it
was racist?
Myth busters
❖ Myth: Pensioners and retirees only care
about themselves.
❖ Fact: Many older people actively
contribute to communities and society.
❖ Over half of home and community
care volunteers in NSW are 65 yrs and over.
❖ 28% of people over 65 yrs
do unpaid voluntary work.
Myth busters
❖ Myth: Older people don’t understand new
technologies.
❖ Fact: Older people are the fastest growing group of
internet users in Australia.
❖ Results of a survey of retirees under 75 years showed
that 53% accessed the internet from home.
Myth busters
❖ Myth: Older people are a burden on society.
❖ Fact: The majority of older people lead productive,
independent lives. They participate in all areas of
society. Many older people continue to work
productively past the retirement age, and they
undertake the bulk of volunteer work.
❖ Many older people in our society play a very active role
in the caring for and raising grandchildren and even
great- grandchildren.
Myth busters
❖ Myth: Older people cannot learn new skills.
❖ Fact: Older people enjoy learning. Many older people
enrol in university courses and adult education
activities.
❖ Myth: Most older people live
in nursing homes.
❖ Fact: The majority of older people
in our society live in private
dwellings and not in institutions.
Myth busters
❖ Nursing myths.
❖ (Of course not all nurses have these views, but you
will come across some of them).
❖ Myth: ‘I want to work in acute care so aged care
nursing is irrelevant to me.’
❖ Fact: A large proportion of clients in acute hospital
wards and units are older people. It is a nurse’s ethical
responsibility to provide optimal ‘care for all
people’ in our society, including the
most vulnerable.
Myth busters
❖ Myth: Nursing the older
person, or gerontology, is uninteresting.
❖ Fact: Working with older adults is an area that demands
skilful and knowledgeable nurses.
❖ In gerontology, the wide age range, societal and common
health issues require that nurses obtain specialised
expertise in this area for effective clinical decision making.
❖ Research in older adults is a growing and well funded area,
with exciting and rewarding opportunities for nursing
research.
Ageism. How can we
make a difference?
❖ Recognise any ageist stereotypes that we may have,
and work to overcome these by treating each person
with respect as an individual.
❖ Become an advocate for the older person and help
reduce ageism by education and training in clinical
settings.
❖ Don’t accept ageist attitudes or ageism silently. When
these occur, either in life situations or in the media,
comment about them and how they mitigate the rights
of the older person.
Ageism. How can we
make a difference?
❖The more that young and middle aged
people reject ageism and ageist stereotypes among
themselves, the more the older person will be viewed in
a positive light.
❖ Discourage ageist stereotyping humour, comment on
this when you see it in the media: films, advertising,
birthday cards- and call it what it is- ageism.
Ageism. How can we
make a difference?
❖Discourage ageist terminology
and labels, such as ‘grumpy old man’ etc.,
❖ Discourage patronising and demeaning terms such as
‘senile’, ‘80 years young’ etc.,
❖ No doubt you can think of may other ways to advocate
for older people and help to stop ageism……..
Can Ageism lead to Elder Abuse?
❖Ageism is defined as stereotyping and discrimination
of older people, solely based on age.
❖ Consequences of this can be reduced opportunities
for economic or social participation.
❖ Ageism can contribute to forms of apathy towards
mistreatment of the older person and tolerance of
attitudes and activities that would be unacceptable in
other age groups.
Can Ageism lead to Elder Abuse?
❖In itself, ageism is abusive to older people because it
does not acknowledge the diverse roles of older people
in society.
❖In summary, ageism can ‘fundamentally provide a
justified platform where abusive activities are
tolerated’ (Phelan, 2008, p. 322)
Abuse of the Older Person
❖ Watch this video for raising awareness of elder abuse

ature=youtu.be
Abuse of the Older Person
❖ As seen in the video, what main types of different
abuse exists under the umbrella of Elder Abuse?
❖ Physical, financial, psychological, sexual.
❖ Abuse can also be in the form of the neglect of an
elderly person.
❖ What are some ways that abuse can manifest?
❖ failure to provide food, fluid, hygiene, personal care.
❖ physical or chemical restraint, over-medication.
❖ hitting, slapping, pushing, threats, bullying,
humiliation.
Abuse of the
Older Person
❖ Elder abuse is under-reported.
❖ WHO recommends that screening for abuse should be
included in all health care delivery areas such as aged care
settings, hospitals and, particularly primary care/
community care settings.
❖ Older adults may not wish to report abuse because of
feeling ashamed to admit that the person mistreating them
is a close family member.
❖ They may also be fearful of being put into an institution if
someone knows their situation.
EAPU Helpline Total call data
What prompted the call
QLD Abuse data 2019/2020
Types of Psychological Abuse
Financial Abuse
Neglect
Social Abuse
Physical Abuse
Australian law and Elder Abuse
❖ In Australia, there is no mandatory reporting of elder
abuse which occurs in community dwelling older adult
populations.
❖ The Domestic and Family Violence Protection Act
1989, contains amendments which were proclaimed in
2003.
❖These amendments broadened the previous Domestic
Violence (Family Protection) Act 1989, to cover forms
of domestic violence other than spousal violence,
which include violence related to elder abuse.
The Aged Care Act
❖ In 2007, amendments made to the Aged Care Act 1997
(Cth), provide for mandatory reporting of certain assaults
made on older adults dwelling in Australian Government
subsidised Aged Care homes.
❖ The Aged Care Act 1997 now requires that physical and
sexual abuse occurring in the above Aged Care facilities
must be reported to the Police and to the Department of
Health, Aged Care Complaints Scheme.
❖ The Aged Care Act 1997 has resulted in closer scrutiny of
Aged Care facilities, their staff, contractors and volunteers.
Helpline in
Queensland
❖In 1997 the Elder Abuse Prevention Unit (EAPU) was
set up in Queensland to help respond to elder abuse.
❖ Among other awareness raising activities, this Unit
offers a confidential telephone helpline which provides
support and advice to victims of abuse, service
providers and family members.
❖ Follow this link to visit the EAPU website:
❖ http://www.eapu.com.au/
Helpline in Queensland
Elder Abuse Awareness Day
 https://elderabuseawarenessday.org.au/
There’s no excuse for elder abuse:
Australian Govt. Campaign.
Summary
❖The major categories of Theories of Ageing have been outlined
and discussed.
❖Ageism (in relation to the older person) and some of the reasons
for this in our society has been explored and discussed
❖ Ageism in the Mass Media has been explored and discussed.
❖ Some of the common Myths regarding the older person have
been negated by presenting facts.
❖How we as nurses and individuals in society can make a
difference in combatting ageism has been explored and discussed
❖How ageism can lead to Elder Abuse has been outlined.
❖An overview of Elder Abuse, relevant laws in Australia and an
Elder Abuse support unit in Queensland has been explored and
discussed.
References
 Aged Care Act 1997 (Cth).
 Biggs, S., & Haapala, I. (2013). Elder mistreatment, ageism, and human rights.
International Psychogeriatrics, 25(8), 1299-1306. doi:
http://dx.doi.org/10.1017/S1041610212002372
 Bramble, M. (2014) What is ageing? In W. Moyle, D. Parker & M. Bramble (Eds.), Care of
Older Adults. A strengths-based approach. Melbourne: Cambridge University Press.
 Chenoweth, J. (2012). Older Adults. In D. Brown & H. Edwards (Eds.), Lewis’s MedicalSurgical Nursing. Assessment and Management of Clinical Problems (3rd ed.).
Chatswood: Elsevier Australia.
 Domestic and Family Violence Protection Act 1989 (Cth).
 Elder Abuse Prevention Unit (2022). Promoting the right of all older people to live free
from abuse. Retrieved from: https://www.eapu.com.au/
 Forrester, K., & Griffiths, D. (2014). Essentials of Law for Health Professionals (4th ed.).
Chatswood: Elsevier Australia.
References

Gatling, M. (2012). Representations of age and ageing in comedy films. Paper presented at the Making
an Impact. 11th National Conference of Emerging Researchers in Ageing, The Greek Club, Brisbane,
Australia.

Gatling, M., Mills, J., & Lindsay, D. (2014). Representations of Middle Age in Comedy Film: A Critical
Discourse Analysis. The Qualitative Report, 19(12), 1.

GILLBARD, A. & LEGGATT-COOK, C. (2020). ELDER ABUSE PREVENTION UNIT: YEAR IN
REVIEW 2019-20

Harwood, J. (2007). Mass communication. Portrayals of older adults. In J. Harwood (Ed.),
Understanding Communication and Aging: Developing Knowledge and Awareness: Sage Publications.

Hunt, S. (2017). Older Adulthood. In J. Crisp, D. Douglas, G. Rebeiro & Waters, D. (Eds.), Potter and
Perry’s Fundamentals of Nursing (5th ed., pp. 394-421). Chatswood: Elsevier Australia.

Nay, R., & Garratt, S. (2014). Older People. Issues and Innovations in Care (4th ed.). Chatswood:
Elsevier Australia.
References
 Nelson, T. (2011). Ageism: The strange case of prejudice
against the older you. In R. L. Wiener & S. L. Willborn
(Eds.), Disability and aging discrimination:
Perspectives in law and psychology (pp. 37-47). New
York: Springer Science and Business Media.
• The Victorian Government Department of Health.
(2016). Healthy Ageing Literature Review. Melbourne:
Victorian Government.
Any Questions?
Susan Nunan. (2022)
Clinical Academic: Course Coordinator:
UQ School of Nursing Midwifery
and Social Work.
Copyright Notice
This material is for the exclusive use of students and staff of the University of Queensland
and should not be reproduced for any other purpose.
Do not remove this notice.
Acknowledgment of Country
The University of Queensland (UQ)
acknowledges the Traditional Owners and their
custodianship of the lands on which we meet.
We pay our respects to their Ancestors and
their descendants, who continue cultural and
spiritual connections to Country.
We recognise their valuable contributions to
Australian and global society.
3
Lecture Objectives
❖This lecture will:
❖Review the key features of dementia, statistics, diagnosis, risk factors,
prevention and pharmacological treatment.
❖Provide a brief overview of capacity and decision making in relation to
dementia.
❖Define person centered care in the context of dementia.
❖Discuss pain assessment and the person with dementia.
❖Overview and discuss person centred communication with the older
person with dementia.
❖Analyse frameworks for implementing person centred dementia care
❖Discuss person centred dementia care using the biographical approach.
What is dementia?
 Umbrella term for a syndrome
 Characterized by impairment of brain functions,
including language, memory, perception, personality
and cognitive skills.
 What are the most common forms of dementia?
 Most common forms: Alzheimers Disease, Vascular,
Fronto-temporal, Lewey -Bodies
 Symptoms and progression may vary
 Generally of gradual onset, progressive and irreversible
Australian Statistics
 In 2021 an estimated 472,000 Australians live with
Dementia
– over 65 years 1 in 10 have dementia
– Over 85 years 3 in 10 have dementia
– In 2021 an estimated 28,300 people have young onset
dementia- from age of 40
– 5 times greater incidence among Indigenous
Australians- 1 in 8 over 45 years have dementia
 Estimated 1.6 million people are involved in caregiving
Australian Statistics
 Dementia is the second leading cause of death in
Australia and the third leading cause of disability
overall
 There is no cure for dementia
 Research for prevention and treatments are ongoing
 Dementia was recognized as the 9th National Health
Priority Area in Australia in 2012
https://www.aihw.gov.au/getmedia/28c917f3-cb0044dd-ba86-c13e764dea6b/Improving-Australia-sburden-of-disease-9-01-2019.pdf.aspx
Changes to the brain
Symptoms are related to the area
of the brain affected
Stages of dementia
Early diagnosis
 Is critical to identify type and potential treatments
 Undertaken by geriatrician or psychiatrist with
expertise in dementia / Memory Clinic
 Medical history and Brain imaging
 Physical and Psychiatric assessment
 Neuropsychological assessment to help with diagnosis
Risk Factors and
Prevention
 Think pair/ share
 What are some of the Risk Factors for Dementia? Non-
modifiable and modifiable?
 What are some possible preventative strategies?
 Non-modifiable: Age, genetics, family history.
 Modifiable: Heart Health, Body Health, Mind Health.
Prevention
 What are some examples of some prevention strategies
for the following modifiable risk factors?
 Heart Health
 Body Health: Physical fitness and health
 Mind Health
Treatment for dementia
Cholinergic treatments
Memantine
 offer some relief from the
 targets a neurotransmitter called
symptoms of Alzheimer’s
disease for some people for a
limited time.
 blocks the actions of an enzyme
called acetylcholinesterase
which destroys an important
neurotransmitter for memory
called acetylcholine
 approved for use for people with
mild to moderate Alzheimer’s
disease.
glutamate that is present in high
levels when someone has
Alzheimer’s disease.
 Memantine blocks glutamate
and prevents too much calcium
moving into the brain cells
causing damage.
 It is the first in a new class of
therapies currently approved for
use for people with moderatelysevere to severe Alzheimer’s
disease.
Non – Pharmacological
Reminiscence
therapy
Life style changes
Stay active
Cognitive
stimulation
therapy
Reality orientation training
Prioritise good
sleep
Challenge the brain
Focus on nutritious diet
Capacity
 Guardianship and
Administration Act
QLD)(2000)
 How do we define capacitysometimes referred to as
competency- in healthcare?
 Capacity: ability of a person
to make their own decisions
about a number of legal,
financial and healthcare
issues – capacity is presumed
 Ability to make an informed
decision – not a ‘good’
decision
 The laws that define capacity
vary in each state and
territory.
Capacity
The Queensland legislation
sets out the definition very
clearly. It states that capacity
for a person means that the
person is capable of:
a) understanding the nature and effect of decisions about the matter; and
b) freely and voluntarily making decisions about the matter; and
c) communicating the decisions in some way.
Decision making
 The decision-making capacity of people living with
dementia may fluctuate and change according to the
situation and context
 The interaction between the person’s condition, the
situation and personal relationships needs to be
considered.
 This does not mean that the person with dementia is
unable to continue to make decisions or be involved in
decisions that affect them.
Types of Decision making
 Supported decision making: involving the person with
dementia :
 Substitute decision making: carers take over decision
making
 Enduring power of attorney: a legal document signed by
a person when they ‘have capacity’ and which gives
another person the power to make personal and
financial decisions on their behalf if they lose the
capacity to make decisions.
 Only around 15% of older people in an Australian study
had a formal EPA
 Public (Adult) Guardian: Appointed by the state.
Decision making resources
 Queensland
 Making health care decisions for others: produced by the
Queensland Government, provides information on how and
when decisions can be made by healthcare decision-makers.
https://www.publicguardian.qld.gov.au/guardianship/healthcare-decisions/making-health-care-decisions-for-others
 Guide to informed decision-making in healthcare:, produced by
the Patient Safety and Quality Improvement Service,
Queensland Health, aims to support practitioners in
understanding the ethical and legal requirements of informed
decision-making about health care.
https://www.health.qld.gov.au/__data/assets/pdf_file/0019/1430
74/ic-guide.pdf
 Guardianship and Administration Act 2000 (Qld): is the
Queensland legislation relevant to substitute decision-making.
http://www8.austlii.edu.au/cgibin/viewdb/au/legis/qld/consol_act/gaaa2000304/
Needs of family caregivers
 Theme 1: Caregiver Needs Related to Managing Care
Recipients
 Information and knowledge
 Formal and informal care support needs
 Theme 2: Caregivers’ personal needs
 Physical and psychological health
 Managing caregiver’s own life
Reframing Dementia
Person with DEMENTIA
PERSON with dementia
NI + H + B + P + SP
 NI: Neurological impairment (and abilities)
 H: Health: Physical and Mental Health.
 B: Biography
 P: Personality(Personhood)
 SP: Social Psychology (care, relationships,
environment)
Personhood
A standing or status that is bestowed upon
one human being, by others, in the context
of relationship and social being. It implies
recognition, respect and trust.
Malignant Social Psychology
 Intimidation: Making a person frightened or
fearful by using spoken threats or physical power
 Withholding: Refusing to give asked for
attention, or to meet an evident need for contact
 Outpacing: Providing information and
presenting choices at a rate too fast for a person
to understand
 Objectification: Treating a person as if they
were a lump of dead matter or an object
Malignant Social Psychology
 Labelling: Using a label as the main way to
describe or relate to a person
 Infantilising: Treating the person in a
patronising way as if they were a small child
 Disparagement: Telling a person that they are
incompetent, useless, worthless, incapable
 Accusation: Blaming a person for things they
have done, or have not been able to do
Malignant Social Psychology
 Treachery: Using trickery or deception to distract
or manipulate a person in order to make them do
or not do something
 Invalidation: Failing to acknowledge the reality
of a person in a particular situation
 Imposition: Forcing a person to do something,
over-riding their own desires or wishes, or
denying them choice
 Banishment: Sending the person away, or
excluding them; physically or psychologically
Malignant Social Psychology
 Disruption: Intruding or interfering with
something a person is doing, or crudely breaking
their “frame of reference”
 Ignoring: Carrying on (in conversation or action)
in the presence of a person as if they were not
there
 Stigmatisation: Treating a person as if they
were a diseased object, an alien or an outcast
 Mockery: Making fun of a person, teasing,
humiliating them and making jokes at their
expense
The needs of a person with dementia-
Model of Person Centred Care:
V=
Valuing people with dementia and those who care for
them.
I=
Treating people as individuals.
P=
Looking at the world from the perspective of the person
with dementia.
S=
Providing a supportive social environment.
Dawn Brooker (2007,2014)
Brown Wilson, (2013, 2017)
Person Centred Communication
 https://padlet.com/uqsue/Communicate
 Go to this padlet link and write about some things that
you think are important to consider for professional
communication with an older person with dementia.
Key principles in
communication
 Timing of the involvement
 Time to process
 Lighting
 Noise
 Language
 Seating arrangements
 Who is involved in the
meeting
 Empathy
 Active listening
 Not making judgments
 Give person full attention
Person-centred dementia care
 https://padlet.com/uqsue/person
 What are some specific things that you think are
important in relation to person-centred dementia care
in health care for staff ant the older person.?
Person-centred
dementia care
 Leadership which facilitates open communication and
responsive working practices
 Working with staff motivation as a starting point to
identify how working practices might be improved
 Adopting communication strategies that value stories
people share- creating community
 Enabling people with dementia to make a
contribution
 Facilitating shared decision making involving the
person with dementia and families
Brown Wilson, 2017
Pain Assessment and the person
with dementia
 Some clients are unable to report pain and levels of pain
 Older adults with advanced dementia fall into this group
 Hierarchy of measures of pain intensity is recommended.
 Attempt to elicit a self-report
 Identify conditions/problems/procedures which may cause
pain
 Observe for pain-related behaviours (behavioural
assessment tool may be used eg. Abbey Pain Scale)
 Indicators of pain information from caregivers/ others
 PRN analgesic trial and observe changes in client behaviour
If you see a change- think Pain.
Video – https://youtu.be/rS7nOq0NYFU
 Video – https://youtu.be/rS7nOq0NYFU
Person centred
care planning
 Use biographical information
 Knowing what is important to the person- personal
routines, activities and concerns
 Consider the person’s unique history.
 Attention to details- what are the significant routines that
provides security for this person
 Consistent approach- communicating the information to
others on the team
 Valuing everyone’s contribution- using information
provided by the person with dementia and their family
 Extrinsic factors in person centred care.
 “Respite space” from institutional routines.
Person Centred Dementia Care
 This powerful film illustrates what Edith, an older
person living with dementia, really wants. Her
insightful words have been created into a poem. HER
words . . . but they reflect the wishes of the silent
many. (Edith’s daughter: Rosemary Hurtley.
 https://www.youtube.com/watch?v=bZvPMIxeCGM
Dementia Support Australia (DSA)
 Improve the quality of life and care for people with
dementia and their carers
 Up-skill, assist and support aged care providers in
improving care for people with dementia and related
behaviours
 Ensure care services for people with dementia are
responsive to their individual and diverse needs and
circumstances.
 https://dementia.com.au/
 https://dementia.com.au/services/severe-behaviourresponse-teams-sbrt
Summary
❖This lecture has:
❖Reviewed the key features of dementia, statistics diagnosis, risk
factors, prevention and pharmacological treatment.
❖Provided a brief overview of capacity and decision making in
relation to dementia.
❖Defined person centered care in the context of dementia.
❖Discussed pain assessment and the person with dementia.
❖Overviewed and discussed person centred communication with
the older person with dementia.
❖Analyses frameworks for implementing person centred
dementia care
❖Discussed person centred dementia care using the biographical
approach.
Useful links
 https://www.worcester.ac.uk/discover/care-fit-for-
vips-online-dementia-care-toolkit.html
 http://www.publicguardian.qld.gov.au/adultguardian/our-decisions/enduring-power-of-attorney2
 http://www.uq.edu.au/ami/financial-capacity-inlater-life
 http://psychologybenefits.org/2016/04/01/can-ahealthy-diet-prevent-dementia-what-the-sciencesays/
 https://www.dementia.org.au/
References

AIHW (2018) Improving Australia’s burden of disease. https://www.aihw.gov.au/getmedia/28c917f3-cb00-44dd-ba86c13e764dea6b/Improving-Australia-s-burden-of-disease-9-01-2019.pdf.aspx

AIHW (2020) Causes of death. https://www.aihw.gov.au/reports/australias-health/causes-of-death

Brooker, D and Latham, I. (2016) Person-Centred Dementia Care, Second Edition. Making Services Better with the VIPS Framework.
London. Jessica Kingsley

Brown Wilson, C. (2013) Caring for older people: a shared approach. London. Sage.

Brown Wilson, C. (2017) Caring for people with dementia: a shared approach. London, Sage

Bramble, M. (2014) What is ageing? In W. Moyle, D. Parker & M. Bramble (Eds.), Care of Older Adults. A strengths-based approach.
Melbourne: Cambridge University Press.

Chenoweth, L., & Samuel, L., (2021). Considering the older person. In Crisp, J., Douglas, C., Rebeiro, G. Waters D. (Eds.) Potter &
Perry’s Fundamentals of Nursing- Australian and New Zealand Edition (6th ed) (pp. 1252-1290). Sydney, Australia: Elsevier.

Dementia Australia (2020) Pain and Dementia. Dementia Q & A 16. Retrieved from:
https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA16-PainAndDementia_english.pdf

Chenoweth, J. (2012). Older Adults. In D. Brown & H. Edwards (Eds.), Lewis’s Medical-Surgical Nursing. Assessment and
Management of Clinical Problems (3rd ed.). Chatswood: Elsevier Australia.

Chenoweth, L., Forbes, I., Fleming, R., King, M. T., Stein-Parbury, J., Luscombe, G., . . . Brodaty, H. (2014). PerCEN: a
cluster randomized controlled trial of person-centered residential care and environment for people with dementia.
International Psychogeriatrics, 26(7), 1147-1160. doi: 10.1017/S1041610214000398

Ferdous, F., & Moore, K. D. (2015). Field Observations into the Environmental Soul: Spatial Configuration and Social Life
for People Experiencing Dementia. American Journal of Alzheimer’s Disease & Other Dementias, 30(2), 209-218. doi:
10.1177/1533317514545378

Forrester, K., & Griffiths, D. (2014). Essentials of Law for Health Professionals (4th ed.). Chatswood: Elsevier Australia.
References



Garcia, L. J., Hébert, M., Kozak, J., Sénécal, I., Slaughter, S. E., Aminzadeh, F., . . . Eliasziw, M. (2012).
Perceptions of family and staff on the role of the environment in long-term care homes for people
with dementia. International Psychogeriatrics, 24(5), 753-765.
Garre-Olmo, J., López-Pousa, S., Turon-Estrada, A., Juvinyà, D., Ballester, D., & Vilalta-Franch, J.
(2012). Environmental Determinants of Quality of Life in Nursing Home Residents with Severe
Dementia. Journal of the American Geriatrics Society, 60(7), 1230-1236. doi: 10.1111/j.15325415.2012.04040.x

Habell, M. (2013). Specialised design for dementia. Perspectives In Public Health, 133(3), 151-157. doi:
10.1177/1757913912444803

Hahn, S. (2015). Using environment modification and doll therapy in dementia. British Journal of
Neuroscience Nursing, 11(1), 16-19.


Harnett, T. (2014). Framing spaces in places: Creating “respite spaces” in dementia care settings.
Dementia (14713012), 13(3), 396-411. doi: 10.1177/1471301212474144

Hunt, S. (2017). Older Adulthood. In J. Crisp, D. Douglas, G. Rebeiro & Waters, D. (Eds.), Potter and
Perry’s Fundamentals of Nursing (5th ed., pp. 394-421). Chatswood: Elsevier Australia.

Joosse, L. L. (2012). Do Sound Levels and Space Contribute to Agitation in Nursing Home Residents
with Dementia? Research in Gerontological Nursing, 5(3), 174-184. doi: 10.3928/19404921-20120605-02
References
 Kitwood, T. 1997 Dementia Reconsidered: the person comes first. Open University Press

Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., . . . Cooper, C. (2014a). Nonpharmacological interventions for agitation in dementia: systematic review of randomised controlled
trials. The British Journal Of Psychiatry: The Journal Of Mental Science, 205(6), 436-442. doi:
10.1192/bjp.bp.113.141119

Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., . . . Cooper, C. (2014b). A
systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and
behavioural interventions for managing agitation in older adults with dementia. Health Technology
Assessment, 18(39), 1-226. doi: 10.3310/hta18390

Nay, R., & Garratt, S. (2014). Older People. Issues and Innovations in Care (4th ed.). Chatswood:
Elsevier Australia.

Pollock, A., & Fuggle, L. (2013). Designing for dementia: creating a therapeutic environment. Nursing
& Residential Care, 15(6), 438-442.

Sprangers, S., Dijkstra, K., & Romijn-Luijten, A. (2015). Communication skills training in a nursing
home: effects of a brief intervention on residents and nursing aides. Clinical Interventions in Aging,
10, 311-319. doi: 10.2147/CIA.S73053

Vasse, E., Vernooij-Dassen, M., Spijker, A., Rikkert, M. O., & Koopmans, R. (2010). A systematic
review of communication strategies for people with dementia in residential and nursing homes.
International Psychogeriatrics / IPA, 22(2), 189-200. doi: 10.1017/S1041610209990615

Vernooij-Dassen, M., Vasse, E., Zuidema, S., Cohen-Mansfield, J., & Moyle, W. (2010). Psychosocial
interventions for dementia patients in long-term care. International Psychogeriatrics, 22(Special Issue
07), 1121-1128. doi: doi:10.1017/S1041610210001365
Any Questions?
Susan Nunan. (2022)
Clinical Academic: Course Coordinator:
With thanks also to Dr Mary Boyde.
UQ School of Nursing Midwifery
and Social Work.
Copyright Notice
This material is for the exclusive use of students and staff of the University of Queensland
and should not be reproduced for any other purpose.
Do not remove this notice.
Acknowledgment of Country
The University of Queensland (UQ)
acknowledges the Traditional Owners and their
custodianship of the lands on which we meet.
We pay our respects to their Ancestors and
their descendants, who continue cultural and
spiritual connections to Country.
We recognise their valuable contributions to
Australian and global society.
3
Lecture Objectives
❖This lecture will:
❖Brief overview of Cardiovascular Disease and its impact on
Older Australians:
❖Provide an overview of some relevant statistics
❖Discuss Cardiovascular disease as one of the National Health
Priorities
❖Overview some of the Risk Factors for Cardiovascular disease
❖Briefly discuss Cardiovascular disease and Indigenous
Australians.
❖Discuss Healthy Ageing and Preventative strategies in relation
to Cardiovascular Disease.
❖Explore cardiac rehabilitation
❖Discuss Heart Failure management and patient education.
Cardiovascular
Disease
 Cardiovascular disease (CVD) is a major cause of
disease and death in Australia.
 The main underlying cause of CVD is atherosclerosis
 Leads to reduced or blocked blood supply to the heart
(causing angina or heart attack) or to the brain
(causing stroke)
 (AIHW, 2019)
Forms of CVD
 What are some forms of CVD?
 Coronary heart disease
 Stroke (Cerebrovascular Accident- CVA)
 Heart failure
 Cardiomyopathy
 Peripheral vascular disease
 Hypertensive disease
 Acute rheumatic fever (ARF)
 Congenital heart disease
Copyright © 2020 Pearson Australia (a division of Pearson Australia Group Pty Ltd)
9781488623301 / LeMone & Burke’s Medical-Surgical Nursing 4e Vol 2
Coronary
Heart Disease
 Two major forms- Angina and Myocardial Infarction
 Prevalence of CHD in Australia:
 around twice as high among men (3.8%) as women
(1.9%).
 increased rapidly with age—around 12 times as high
in people aged 75 and over, as in those aged 45–54
(13.9% and 1.1%, respectively).
 (AIHW, 2020)
Cerebrovascular Accident (CVA)
 From 2018 Self-reported ABS data
 Prevalence of stroke was:
 higher in males than females (1.6% and 1.1%
respectively).
 more common in older age groups
 71% people who had a stroke were aged 65 and over.
Heart Failure
 Heart failure predominantly affects older Australians.
Two-thirds of adults with heart failure (69,500 people)
were aged 65 and over.
 Based on 2018 ABS self-reported statistics
National Health Priorities
 National Health Priority Areas (NHPAs)
 The 9 NHPAs agreed by the Australian Health Ministers’
Advisory Council between 1996 and 2012 were:
 1.Cancer control (1996)
 2.Cardiovascular health (1996)
 3.Injury prevention and control (1996)
 4.Mental health (1996)
 5.Diabetes mellitus (1997)
 6.Asthma (1999)
 7.Arthritis and musculoskeletal conditions (2002)
 8.Obesity (2008)
 9.Dementia (2012)
National Health Priorities
 Cardiovascular Health
 Reasons for Selection: 1 in 6 Australians
had cardiovascular disease in ’06-’07, 1 in 3 over the age
25 had high blood pressure (’99-2000), 11%
health expenditure (’04-’05), 1 in 3 deaths caused by
CVD in 2009 (mortality, YLL)
Risk Factors for CVD
 Follow this word cloud link below and write any risk
factors, Modifiable or Non-modifiable for CVD which
come to mind.
 https://apps.elearning.uq.edu.au/wordcloud/94211
Copyright © 2020 Pearson Australia (a division of Pearson Australia Group Pty Ltd)
9781488623301 / LeMone & Burke’s Medical-Surgical Nursing 4e Vol 2
Risk Factors for CVD
Lifestyle Risk Factors
 Smoking
 Unhealthy diet
 Being inactive
 Unhealthy weight (Obesity)
 Alcohol
 (Heart Foundation, 2020)
Health conditions which increase
risk of CVD
 High blood pressure
 High cholesterol
 Diabetes
 Mental health
 (Heart Foundation, 2020)
Non-modifiable
Risk Factors
 Family history of heart disease
 Female-specific risk factors
 Indigenous Australians
 Ethnic background
 Social environment
Indigenous
Australians
 CVD is a substantial problem for the Aboriginal and
Torres Strait Islander community
 Many Aboriginal and Torres Strait Islander people
report that they have CVD
 It is also the leading cause of death among Aboriginal
and Torres Strait Islander people
 risk factors for CVD are common among Aboriginal
and Torres Strait Islander people
 (Australian Indigenous Health InfoNet, 2020)
Indigenous
Australians
 Actions to improve cardiovascular disease rates for
Aboriginal and Torres Strait Islander people
 increasing the number of Aboriginal and Torres Strait
Islander people working in primary and tertiary health
services
 improving communication between health providers
 defining and overcoming barriers to cardiac specialist care
in regional and remote settings
 establishing Aboriginal and Torres Strait Islander CVD
coordinator positions in tertiary hospitals
 ensuring that programs are culturally sensitive and
integrated
 (Australian Indigenous Health InfoNet, 2020)
Copyright © 2020 Pearson Australia (a division of Pearson Australia Group Pty Ltd)
9781488623301 / LeMone & Burke’s Medical-Surgical Nursing 4e Vol 2
Healthy Ageing and Cardiovascular
Disease
 Improve Diet:
 https://www.betterhealth.vic.gov.au/health/Videos/he
art-disease-eating-for-a-healthy-heart-heartfoundation
Healthy Ageing and Cardiovascular
Disease
 Stop smoking:
 https://www.facebook.com/TheAustralianNationalUni
versity/videos/smoking-our-worstheartbreaker/451160065466642/
Healthy Ageing and Cardiovascular
Disease
 Exercise for Heart Health:
 https://www.youtube.com/watch?v=5tyUa7tTJgI
 Literature Review
 Effects of exercise on cardiovascular performance in the elderly
 Leosco, D. (2014) Frontiers in Physiology:
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929838/
Healthy Ageing and Cardiovascular
Disease
 Lose weight for heart health
 https://www.youtube.com/watch?v=TMDldXoDLrQ
Biological Versus Chronological
Aging
 Literature Review:
 Hamczyk, M et al. (2020)
 Journal of the American College of Cardiology:
 https://www.onlinejacc.org/content/75/8/919
Magda R. Hamczyk et al. J Am Coll Cardiol 2020;75:919-930
2020 The Authors
Magda R. Hamczyk et al. J Am Coll Cardiol 2020;75:919-930
2020 The Authors
Magda R. Hamczyk et al. J Am Coll Cardiol 2020;75:919-930
2020 The Authors
Cardiac Rehabilitation
Video – Cardiac Rehabilitation
Cardiac Rehabilitation
• Level 1, Grade A evidence, that
attendance at Cardiac
Rehabilitation (CR) after a cardiac
event decreases morbidity and
mortality, reduces risk of hospital
admissions, and improves quality
of life6
• Multidisciplinary approach
• Phase 1- Bedside education
− Introduction to disease, risk
assessment & self management
• Phase 2- Education and Exercise
6 Chew et al 2016
Phase 2- Cardiac Rehabilitation
➢ Individualised initial assessment to identify physical,
social and psychological factors that influence
cardiovascular health
➢ Professionally supervised multidisciplinary out patient
program /tele-health/phone-base
➢ Education to assist patients to make lifestyle changes to
address CVD risk factors
➢ Education to optimise monitoring of symptoms, selfmanagement and medication adherence
➢ Assistance to improve or return to daily functioning
➢ Programs run between 4-8 weeks
➢ Return to exercise safely
My Heart My Life booklet
Physical Activity
and returning to
normal daily
activities
My Heart My Life
Aim for at least 30 minutes of moderate intensity physical
activity on most days of the week
Medication managment
My Heart My Life
Eating healthy food
➢ Eat vegetables, fruit,
wholegrains, nuts and seeds;
lean meats, poultry, fish and
seafood
➢ Reduced fat dairy
➢ Healthier fats including
nuts, seeds, avocados, olives
and their oils for cooking.
➢ Salt : aim for foods with < 400mg salt/100g ➢ Alcohol: no more than 2 standard alcoholic drinks/day Psychosocial ➢ Depression & anxiety – often linked to CAD ( depression is a risk factor of CAD) ➢ Returning to work ➢ Financial issues ➢ Social support/ social isolation ➢ Manage emotional and social life Monitoring Chest pain: Angina. ➢ Treat chest pain with GTN spray using the cheat pain action plan ➢ If pain is happening regularly it is important to seek help Heart Failure Aims of Treatment ➢ Improve symptoms, quality of life ➢ Improve exercise tolerance ➢ Improve LV function ➢ Decrease hospital admissions ➢ Improve survival Managing Heart Failure ➢ Medical ▪ Drugs ▪ Procedures ▪ Tests ➢ Non-medical ▪ Self management ▪ Lifestyle changes Heart Failure Management Programs ➢Nurse led by Nurse Practitioner ➢Multidisciplinary ➢Education and Exercise gyms ➢Titration clinics ➢Telehealth /Telephone support Self Management Educate patients to…….. 1. Take medications as directed everyday 2. Monitor symptoms and weigh every day 3. Limit fluid intake (if appropriate) 4. Limit salt intake 5. Engage in physical activity each day Medications Medications are used to ➢ Relieve symptoms ➢ Decrease disease progression and decrease mortality Symptom monitoring ➢ Sudden weight gain (daily weight) ➢ Shortness of breath ➢ Dry irritating cough ➢ Tiredness/fatigue ➢ Ankle/abdominal swelling ➢ Loss of appetite ➢ Faintness or dizziness ➢ Chest pain Living well with heart failure Monitoring Daily weight Help to notice a sudden weight gain indicating fluid gain. • Wake up • Wee • Weigh • Write it down and compare If more than 2kg is gained or lost over 2 days, contact your HF nurse or doctor. Excess salt is a major cause of preventable hospitalisation in HF 1 teaspoon = 2g salt Recommended intake  2gms per day  Aim for foods that contain 120mg salt per 100g or less Tips to reduce salt intake ➢ Don’t add salt to cooking, or at the table ➢ Flavor food with herbs/spices, garlic etc. ➢ Limit high salt foods ➢ Avoid packaged snacks and meals ➢ Read labels ➢ Avoid high salt foods Which of the following contains more sodium? 100g of cottage cheese 100g of self-raising flour 365mg 100g of tomato juice 980 mg 100g of chicken noodles 861 mg 100g of Self-Raising Flour 1491 mg Evidence for Patient Education ➢ Self-management education Improved knowledge of illness ➢ Improved health related QoL ➢ Improved self-management strategies 12 Stenberg et al., 2016 ➢ Decrease rehospitalisations 14 Boyde 2018 Effects of patient education in people with CHD ➢ Reduced all cause mortality ➢ Reduced cardiac morbidity ➢ Decreased healthcare costs ➢ Improved health related QoL 13 Brown et al., 2013 Summary ❖This lecture has: ❖Briefly overviewed Cardiovascular Disease and its impact on Older Australians: ❖Provided an overview of some relevant statistics ❖Discussed Cardiovascular disease as one of the National Health Priorities ❖Overviewed some of the Risk Factors for Cardiovascular disease ❖Briefly discussed Cardiovascular disease and Indigenous Australians. ❖Discussed Healthy Ageing and Preventative strategies in relation to Cardiovascular Disease. ❖Explored cardiac rehabilitation ❖Discussed Heart Failure management and patient education. Some References  Australian Bureau of Statistics (2020). Data Cardiovascular Disease. https://www.abs.gov.au/ausstats/abs  Australian Institute for Health and Welfare (2020). Data health conditions, Cardiovascular Disease.  https://www.aihw.gov.au  Health InfoNet (2020). Health topics, Cardiovascular Health.  https://healthinfonet.ecu.edu.au  Hamczyk, M., Nevado, R., Barettino, A., Fuster, V., Andres, V. (2020) Biological Versus Chronological Aging. Journal of the American College of Cardiology, 75(8), doi: 10.1016/j.jacc.2019.11.062  Heart Foundation (2020). Risk of heart disease.  https://www.heartfoundation.org.au  Vigorito, C., & Giallauria, F. (2014) Effects of exercise on cardiovascular performance in the elderly. Frontiers in Physiology, 5(51). Doi: 10.3389/fphys.2014.00051 Some More References 1. 2. 3. 4. 5. 6. 7. Woodruffe et al., Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart, Lung and Circulation. 2015;1;24(5):430-41 AIHW Cardiovascular Disease 2020 https://www.aihw.gov.au/reports/heart-stroke-vasculardiseases/cardiovascular-health-compendium/contents/impact Atherton, J. et al., National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart, Lung and Circulation, 2018;27(10), 1123-1208 Mayberry, L., et al.,Health Literacy and 1-Year Mortality: Mechanisms of Association in Adults Hospitalized for Cardiovascular Disease, Mayo Clinic Proceedings,2018; 93:12; 1728-1738 Stenberg, et al., A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness. Patient Education and Counseling, 2016;99(11):, 1759–1771. Brown, J. P., et al., Effect of patient education in the management of coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. European Journal of Preventive Cardiology, 2013;20(4), 701–714 Boyde, M., et al., Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial. European Journal of Cardiovascular Nursing, 2018;17(2), 178-185 Any Questions? Older Adults Health Susan Nunan 2022 with thanks also to Denita Ward and Kathy Hocking. Wound Prevention and Management and the Older Adult Copyright Notice This material is for the exclusive use of students and staff of the University of Queensland and should not be reproduced for any other purpose. Do not remove this notice. Acknowledgment of Country The University of Queensland (UQ) acknowledges the Traditional Owners and their custodianship of the lands on which we meet. We pay our respects to their Ancestors and their descendants, who continue cultural and spiritual connections to Country. We recognise their valuable contributions to Australian and global society. Learning Objectives 01 03 Skin changes in older adults Wound healing 02 04 Common Wounds in older adults & Prevention Wound assessment 05 Wound management Skin changes in older adults 01 Layers of the Skin (Parker & Kaim 2021) Function of the skin ❖ Protection ❖ Temperature control ❖ Sensation ❖ Metabolism ❖ Communication (Nguyen & Soulika; Parker & Kaim 2021) Skin Changes Associated With Ageing Intrinsic Ageing • • • • • • • • • Reduction in Collagen and elastic fibres Decreased sensory perception Sebaceous and sweat gland activity decreases Decreased peripheral circulation Subcutaneous fat tissue decreases Genetics/family history Hormones Chronic illness (diabetes) Weight/nutrition Extrinsic Ageing • • • UV radiation exposure Cigarette smoke Pollution (Parker & Kaim, K 2021) Common Wounds in Older Adults & Prevention 02 Pressure Injury - localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction pressure ulcer, pressure sore, bed sore take a long time to heal – and affects quality of life ➢ Pain/discomfort ➢ Sleep disturbances ➢ Mood disturbances ➢ Susceptibility to infection ➢ Decreased mobility ➢ Longer hospitalisation (ACSQHC 2018) Statistics • Pressure Injuries (PIs) recognized as a preventable safety issue • Indicator of quality health care • Costly to both patients and healthcare system • In 2012-13 PI’s were estimated to cost AUS healthcare $983 million annually • 122,000 PI cases • ICU patients 4 times at risk for PI’s than non-ICU patients • 4,313 PI’s occurring in AUS public hospitals in 2015-16 (Yarad et al 2020; ACSQHC 2018) Stages of pressure injury Non-blanchable erythema over a bony prominence, epidermis is intact Partial thickness loss of the dermis, shallow open ulcer Full thickness skin loss, subcutaneous fat may be visible, but bone/muscle not exposed Most severe, full thickness tissue loss with exposed bone, tendon or muscle Full thickness tissue loss, wound is covered with necrotic tissue (eschar or slough) Risk Assessment Waterlow, Braden and Norton tools Rate risk as no risk, low, medium or high risk Risk Factors • Alteration in mobility • Nutritional status • Sensory impairment • Surgery or trauma • Neurological status • Incontinence, drainage, perspiration • Co-morbidity (Parker & Kaim, 2021) Prevention ❖ Regular skin inspection daily or with repositioning ❖ Skin hygiene – moisture associated skin damage (MASD) ❖ Avoid rubbing or massaging bony prominences ❖ Prevent shear and friction ❖ Monitor nutrition and hydration ❖ Support surfaces (Clinical Excellence QLD 2019; Parker & Kaim, 2021) Skin tears - Traumatic injury as a result of friction alone or shearing and friction Separates the epidermis from the dermis or Separates the epidermis and the dermis from underlying structures Common sites include ➢ Arms, hands ➢ Lower legs, feet, head - Risk in older adults ➢ Skin aging results in less elastin and collagen ➢ Less flexibility, sagging, wrinkling, dryness ➢ Decreased subcutaneous tissue, epidermis thins ➢ Skin more easily damaged (Clothier 2014) (Parker & Kaim, 2021) Risk Factors • • • • • • • • • • History of previous skin tears Advanced age Poor nutrition Dehydration Cognitive Impairment Dependency Multiple medications Impaired mobility Co-morbidities Incontinence (Parker & Kaim, 2021) Prevention ❖ Protect fragile skin, with clothes or bandages or limb protectors ❖ Skin hygiene – pH neutral, cleanser and moisturiser ❖ Avoid adhesive dressings ❖ Prevent shear and friction ❖ Monitor nutrition and hydration ❖ Protective padding on furniture, equipment ❖ Adequate lighting (Parker & Kaim, 2021) Leg Ulcers Venous leg ulcers ➢ Most common type of leg ulcer ➢ 70% of all leg ulcers ➢ High blood pressure & valve failure ➢ Fluid leaks into surrounding tissues and skin ➢ Inflammation causes skin breakdown Arterial leg ulcers ➢ Less common type of leg ulcer ➢ 10% of all leg ulcers ➢ Peripheral arterial disease Diabetic foot ulcer ➢ Neuropathy – ➢ Skin changes ➢ Loss of sensation ➢ Peripheral arterial disease (Packer et al 2021; Parker & Kaim, 2021) Characteristics of Leg Ulcers Venous Arterial Diabetic Location Above ankle bones Toes, shin, pressure points Soles of foot, toes Appearance of wound bed Ruddy granular Pale grey or yellow Red granular, pale grey or yellow Wound shape Flat, irregular Smooth, punched out Callused wound margins Exudate Moderate to heavy Low to moderate Low to heavy Surrounding skin Oedema, swelling, ruddy brown colour Shiny, taut skin, cold legs & feet, absence of hair, dusky red or blue (cyanosed) colour Dry callused skin, cold legs & feet, absence of hair Pain Ranges from no pain to severe, worse after standing long periods Severe cramping pain at rest or after walking short distance Painless (due to loss of sensation) (Parker & Kaim, 2021) Risk Factors ❑ ❑ ❑ ❑ ❑ Decreased mobility History of DVT Sitting or standing for long periods Heart failure Hypertension ❑ ❑ ❑ ❑ Peripheral arterial disease (PAD) Smoking Diabetes Obesity ❑ Uncontrolled or prolonged hyperglycaemica ❑ PAD (Parker & Kaim, 2021) Prevention ❖ Protect fragile skin, with clothes or bandages or limb protectors ❖ Skin hygiene – pH neutral, cleanser and moisturiser ❖ Ensure shoes are well fitting and always worn ❖ Podiatrist to cut toe nails ❖ Lower limb exercises- avoid crossing legs ❖ Elevate legs when sitting ❖ Smoking cessation ❖ Monitor nutrition and hydration ❖ Protective padding on furniture, equipment ❖ Adequate lighting ❖ Venous ulcers – compression stockings (Parker & Kaim, 2021) Wound healing 03 Modes of wound healing ➢ Primary Intention – clean surgical incision closed with sutures/staples ➢ Secondary Intention – extensive loss of tissue, heals through granulation and epithelialisation Tertiary Intention/delayed primary intention – delayed closure (Parker & Kaim, 2021) ➢ VIDEO - 4 Phases of wound healing Phases of wound healing HAEMOSTASIS INFLAMMATION PROLIFERATION MATURATION Vasoconstriction, formation of platelet plug, development of clot, retraction and compaction of clot Vascular and cellular response that removes microbes, and dead tissue. Vasodilation. Increased blood flow produces heat, redness, and throbbing Fibroblasts produce collagen and elastin fibres which form the granulation tissue, angiogenesis continues, wound contraction and epithelialisation Collagen synthesis continues after wound closure, but forms more organised structure that increases scar tissue tensile strength (Parker & Kaim, 2021) http://www.intechopen.com/books/stem-cells-in-clinic-and-research/topical-stem-and-progenitor-cell-therapy-for-diabetic-foot-ulcers Factors affecting wound healing ❑ Co-morbidities – CAD, diabetes, heart failure ❑ Nutrition – protein, zinc, vitamin C needed for cell regeneration ❑ Hydration – needed for efficient blood flow ❑ Medications – suppress inflammatory response (NSAIDs, steroids) ❑ Age – Slower cell regeneration, age related skin changes, co-morbidities ❑ Atherosclerosis – poor delivery of oxygen and nutrients to wound ❑ Infection – wound does not move past inflammation stage ❑ Heavy exudate – increased risk for infection and breakdown of wound ❑ Dry wound – scab formation delays epithelisation ❑ Smoking – related to CAD (Molnar et al 2014; Parker & Kaim, 2021) Wound Assessment 04 The Golden Rules of Wound Management 1. Assessment a. holistic b. aetiology 2. Address factors that may impede healing 3. Wound Bed Preparation 4. Product selection 5. Plan, for lifelong maintenance Word Cloud – Considerations and Principles of Wound Assessment https://apps.elearning.uq.edu.au/wordcloud/94211 Assessment- Look at the “Whole” person • Consider: • Infection • Continence • Sleep • Psychological state • Disease • Nutrition • Social circumstances • Anaemia • Smoking • Age • Blood supply • Mobility • Motivation • Drugs Wound Assessment History When did it start, how did it start, what treatments, type of wound Location Indication of wound type – venous, arterial, diabetic ulcer, pressure injury, skin cancer Size Measured to track progress. Trace margins, ruler, probe, photography Edge Indication of wound type – punched out, sloping, callused, raised Wound Assessment Appearance Black – necrotic Red – granulating Green - infected Yellow – slough Pink – epithelialising Exudate Type, amount, colour, consistency, and odour of wound drainage. Serous, haemoserous, sanguineous, purulent. Surrounding skin Assists with appropriate dressing. Callus, maceration, oedema, erythema, desiccated. Pain Indication of infection, poor blood supply. Result of dressing change. Assessing for Infection ❖ Heat in surrounding skin ❖ Erythema surrounding skin ❖ Oedema surrounding skin ❖ Pain increased intensity ❖ Delayed healing ❖ Wound tissue bleeds easily ❖ Purulent exudate ❖ Offensive odour ❖ Abnormal granulation tissue (Parker & Kaim, 2021) Assessment – wound base Assessment- Exudate Volume Colour, Consistency, Odour • None- Wound tissue is dry • Serous- thin amber/straw fluid • Scant- Wound tissue moist • Serosanguineous- thin pink/light red • Small- Wound tissue is wet • moisture evenly distributed • 25% of dressing involved • Sanguineous- thin, red • Moderate- Wound tissue saturated • Moisture may/not be evenly distributed • 25-75% of dressing involved • Copious- Wound tissue bathed in fluid • Drainage freely expressed. • Seropurulent- thin, cloudy, creamy, yellow/tan • Purulent- thick, milky yellow/tan or brown, sometimes green • Haemopurulent- thick, reddish milky opaque • Haemorrhagic- thick, red Assessment – Wound edges/surrounding skin Flat Healthy Macerated Rolled Assessment – Infection • Increased Pain • Erythema • Oedema • Increased Exudate • Warm to touch/ heat Elderly and wound healing • Intrinsic changes – • Collagen reduction • Reduction of elastic fibers (glycosaminoglycans and proteoglycans) • Nutrition • Hydration • Extrinsic • UV light exposure • Cigarette smoke • Pollutants Photo courtesy of J. M. Levine, MD Wound Management 05 Wound bed preparation CLEANSING Help prevent wound infection, remove excess debris, rehydrate wound. (Manna et al 2021; Parker & Kaim, 2021) DEBRIDEMENT Removal of dead tissue such as – slough and necrosis, dry eschar. Prepare wound for re-epithilialisation. MOIST ENVIRONMENT Essential to promote optimal healing so new cells can migrate across a wound bed VIDEO - Moist wound healing Dressing Types (Brawn 2020) Summary Skin changes in older adults Common Wounds in older adults & Prevention Wound healing Wound assessment Wound management THANKYOU! CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik REFERENCES Australian commission on safety and quality in health care (2018) Hospital acquired complication pressure injury. https://www.safetyandquality.gov.au/sites/default/files/2019-05/saq7730_hac_factsheet_pressureinjury_longv2.pdf Brawn, K. (2020). Guidelines for the assessment and management of wounds. NHS Foundation Trust. https://static.s123-cdn.com/uploads/3851963/normal_5f2c2d43553b6.pdf Clinical excellence Queensland. (2019). NSQHS Standard 5 Comprehensive Care. Preventing and managing pressure injuries. https://clinicalexcellence.qld.gov.au/sites/default/files/docs/resourses/nsqhs-standards/s5-ed2-def.pdf Clothier, A. (2014). Assessing and managing skin tears in older people. Independent Nurse. https://www.independentnurse.co.uk/clinical-article/assessing-and-managing-skin-tears-in-older-people/63411/ Manna, B., Nahirniak, P., Morrison, C. (2021). Wound debridement. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK507882/ Nguyen, A. & Soulika A. (2019) The dynamics of the skins immune system. Int J Molecular Science. 20(8):1811. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515324/ Molnar, J., Underdown, M., Clark, W. (2014). Nutrition and chronic wounds. Advances in Wound care. 3(11): 663-681. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217039/ REFERENCES Packer, C., Ali, S., Manna, B. (2021). Diabetic ulcer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: https://www.ncbi.nlm.nih.gov/books/NBK499887/ Parker, C & Kaim, K. (2021). Optimising skin integrity and wound care. In J. Crisp, D. Douglas, G. Rebeiro & Waters, D. (Eds.), Potter and Perry's Fundamentals of Nursing (6th ed., pp. 477-546). Chatswood: Elsevier Australia. Yarad, E., O’Connor, A., Meyer, J., Tinker, M., Knowles, S., Li, Y., Hammond, N. (2020). Prevalence of pressure injuries and the management of support (mattresses) in adult intensive care patients: A multicentre point prevalence study in Australia and New Zealand. Australian Critical Care 34. pg. 60-66. https://www.australiancriticalcare.com/article/S10367314(20)30210-1/pdf NURS7125 IBL Week 9 Module 6: Skin Integrity Health Conditions. Activity 1: Mr Bukowski: Case Study Mr Bukowski, aged 78 years, is a widower who lives at home. His daughter lives nearby. Mr Bukowski typically uses a wheelie walker to mobilise because he often is unsteady on his feet however he doesn’t use it much at home. On the way to his letter box he trips and stumbles. Fortunately, he falls into the front fence which breaks the fall however he sustains a large skin tear on his left arm. When he gets back inside he applies some paper towel to stop the bleeding, knowing that his daughter is coming over for morning tea and can fix it up then. A few hours later, Mr Bukowski’s daughter arrives and decides to take her father to his general practice (GP) clinic because she isn’t sure what to do. On arrival at the GP clinic Mr Bukowski is taken through to the treatment room to be seen by the practice nurse. This is not the first time that he has sustained skin tears. On examination, the registered nurse notices that Mr Bukowski has multiple skin tears on the left forearm with extensive bruising. Mr Bukowski has a past medical history of a STEMI in 2014; Stents x 3 inserted but still has ongoing angina. Moderate congestive cardiac failure, chronic obstructive pulmonary disease and hypertension. His medications include daily aspirin, lisinopril, carvedilol, frusemide and a multivitamin. He also has a salbutamol inhaler prn. Mr Bukowski currently smokes 15 cigarettes a day and has done so ever since leaving school at the age of 16. (Scenario adapted from Wilson & Gibb 2017) What factors might have contributed to the development of Mr Bukowski’s skin tear? Explain if this wound healing is by primary or secondary intention Explain if his tear is an acute or a chronic wound. How would you classify this skin tear? What is the phase of wound healing in this tear? With reference to the Mr Bukowski’s skin tear…. Describe the characteristics that would indicate whether or not this wound was infected State the predominant tissue type in the wound bed. How would you describe the wound edges? How would you describe the skin around the wound? How would you cleanse this wound? What dressing type would you choose at this point, and why? How would you manage the skin around the wound? What self-help advice would you give to Mr Bukowski? What strategies would you recommend to prevent skin tear recurrence in the future? Are there any other healthcare professionals you would liaise with in this case? Activity 2 Six months later Mr Bukowski re-presents at the GPs with a new wound located on his left shin. The wound is failing to heal despite Mr Bukowski trying to dress the wound regularly with left over dressings from his earlier skin tear. Mr Bukowski states that the wound has been present for approximately 4 months. The wound has gradually been increasing in size and it has been oozing. He says that sometimes he has to change the dressings every day because the dressings become very wet. Mr Bukowski has noticed that his skin is very dry and scaly around he wound. He reports that the wound is sometimes painful, particularly after he has been standing for a while, and that the pain is worse when he first gets out of bed in the morning and by late in the afternoon. He has also noticed that his ankles have become quite swollen and finds that elevating his legs can help to reduce his pain and swelling. Mr Bukowski reports feeling a bit ‘out of sorts’; he can’t go out like he used to because he is fearful that the wet dressings will ruin his good clothes and his wound might get worse. He hasn’t told his daughter about his wound because he doesn’t want to worry her. What factors are likely to have led to the development of Mr Bukowski’s leg ulcer? Based on the history and clinical examination data, what type of leg ulcer might this be? Explain if this wound is healing by primary or secondary intention? What characteristics would indicate if this wound was infected? What is the risk of Mr. Bukowski becoming socially isolated? What strategies would you recommend to prevent leg ulcer recurrence in the future? Are there any other healthcare professionals that you would liaise with in this case? Activity 3: produce an educational brochure focused on one particular wound type https://templates.office.com/en-au/brochures Pressure injury Skin tear Traumatic wound eg jagged glass Surgical wound Leg ulcer Burn ➢ Each group to present your brochure to the larger group ➢ Each group has 5 minutes to present their work Presenting back to the larger group Thank you NURS7127 Week 7 IBL Dr Jacqueline Jauncey-Cooke Acknowledgment of Country The University of Queensland (UQ) acknowledges the Traditional Owners and their custodianship of the lands on which we meet. We pay our respects to their Ancestors and their descendants, who continue cultural and spiritual connections to Country. We recognise their valuable contributions to Australian and global society. 2 Background Marilyn Bank (71 years old) was recently released from the hospital following observation for chest pain and discomfort. She was referred to a cardiac rehabilitation centre where you are working as a registered nurse. During her 1st appointment you review her medical record. Last week Marilyn was shopping when she experienced chest pain and some discomfort, which radiated down her left arm. She was brought by ambulance to the local hospital. She described the pain as a squeezing sensation and indicated that she had previously experienced episodes where she felt short of breath. 3 Marilyn’s details Medical history; • Type II non-insulin dependant diabetic • Otherwise well. Medication regime; Lipitor (atorvastatin calcium) 40 mgs orally daily and metformin HCl (glucophage) 850 mgs twice a day • 1.7 metres tall, weighs 93kgs • Strong familial history of cardiac disease, father had an MI at 66 and her brother has had an angioplasty and stents x 2 Recent blood tests • Troponin, Creatine Kinase, and Myoglobin levels WNL • B-type natriuretic peptide WNL • Total blood cholesterol was elevated at 7.4 mmol/L with LDL 4.4 mmol/L and HDL at 1.0 mmol/L. • Triglycerides were 2.4 mmol/L • Glucose levels were WNL Recent blood pressure result Today: 153/98mmHg Discharge last week: 135/85 Social Hx Lives alone, independent Adult children x 2, one lives nearby 4 During the recent admission • Electrocardiograph (ECG) was normal but a stress test indicated a prolonged Q-T interval after 5 minutes of exercise on a treadmill. • Subsequent assessment with coronary angiography indicated a blockage of approximately 50% in the left anterior descending coronary artery. • She was discharged with orders to implement lifestyle changes, hence the visit to the cardiac rehabilitation centre, and to return for a follow-up visit in 2 weeks. • Increased dosage of Lipitor (atorvastatin calcium) to 80 mg orally daily a • Prescribed Lopressor (metoprolol tartrate) 100 mg orally daily. • Prescribed Nitrostat (nitroglycerin) 0.3 mg tablets to be used in the event of angina • Daily dose of low-dose aspirin (81 mg). 5 Group questions What risk factors for coronary heart disease (CHD) does Marilyn have? Examine and evaluate Marilyn’s blood results. Evaluate the blood work results for Marilyn and identify those that indicate Marilyn may have CHD. Evaluate the results of the ECG and stress test. Why did Marilyn’s physician initiate changes in her Lipitor (atorvastatin calcium) dosage? What purposes do the specific medications listed serve and what are the nursing responsibilities when administering these? Develop a risk management plan for Marilyn including the lifestyle changes you would suggest. What is the role does cardiac rehabilitation play for a person with CHD. What education would you provide Marilyn related to: Diet; Physical Activity; Friendship and Social Relationships? 6 Madeline Brunner Madeline is an 84-year-old woman that you are visiting in her home for wound care. She developed a pressure ulcer during her hospitalization for a left total hip replacement. The wound and her hip are doing well but she complains that she is not feeling well today and thinks she is “coming down with a cold.” She has had a non-productive cough with increased shortness of breath for the past 2 days and has needed to sleep in her recliner because she is uncomfortable lying in her bed. Her appetite has been poor, which she attributes to the fact that she has been constipated with the analgesia prescribed after her surgery. She has been able to take ample quantities of beef and chicken broth only for the past few days due to an upset stomach. 7 Current medications Madeline Hx Physical assessment Medical history ➢BP 110/62; pulse 102; respirations: 22; O2 sat 92% ➢CHD with myocardial infarction (MI) in 2007 ➢Heart sounds: S1,S2 with S3 gallop, no murmurs or rubs ➢Congestive heart failure (CHF) ➢Lung sounds: rales in bases ➢Osteoarthritis in her hips with left hip replacement 6 months ago ➢ABD: soft, non-tender, distended with positive hepatojugular reflex; ➢Hypertension ➢Hypercholesterolemia ➢bowel sounds normal in all four quadrants ➢Extremities: capillary refill less than 2 seconds, 2+ oedema bilaterally ➢Lasix (frusemide) 40 mg every morning ➢K-Dur (potassium chloride) 20 mmol/L every morning ➢Lopressor (metoprolol) 25 mg, 0.5 tablets twice a day ➢Prinivil (lisinopril) 10 mg every morning ➢Vicodin (acetaminophen/hydrocodone) 500/5 mg, 1 tablet three times a day ➢Aspirin 81 mg daily ➢Zocor (simvastatin) 20 mg every evening ➢Advil (ibuprofen) 400 mg three times a day ➢Seasonal flu shot was given in late April ➢1st dose of Astra Zeneca – 2nd appointment booked for mid October 8 Group questions ➢What do you suspect may be causing Madeline’s symptoms? ➢What are the pertinent positive findings on your physical assessment and explain the pathophysiology of each of these findings. ➢What may have precipitated this problem? ➢Does Madeline demonstrate symptoms of right- or left-sided heart failure, or both? Explain. ➢How is Heart Failure diagnosed? ➢What medications does Madeline take to treat her heart failure and what nursing responsibilities and health education would you provide for Madeline and family? ➢ What are the main goals of nursing care for Madeline? ➢ Madeline’s primary care physician orders a B-type natriuretic peptide (BNP), chest x-ray, EKG, and echocardiogram and increases the dose of her Lasix (furosemide) and Potassium Chloride. What is the purpose of these diagnostic tests and medication change? ➢How can you help educate Madeline to prevent future Heart Failure exacerbations and hospitalizations related to this condition? 9 For further information j.jaunceycooke@uq.edu.au CRICOS Provider 00025B Older Adults’ Health: IBL Week 1 NURS7125 School of Nursing, Midwifery & Social Work The University of Queensland CRICOS code 00025B CRICOS code 00025B Overview of this session • What is the biographical approach to assessment? • Medication errors in older adults • What are strategies that could be implemented to improve medication management in older adults - Nursing perspective - Interprofessional perspective CRICOS code 00025B 3 Case study ➢Eileen's Story (video one: 3.5mins) https://www.wiimali.com.au/meet-eileen-poole/ (watch only the “meet Eileen Pool” video only) Eileen then goes to her Doctor’s appointment and meets the Practice Nurse: ➢Practice nurse: Scenario A (video two: 1.5 mins) https://www.wiimali.com.au/eileen-poole-at-the-gp-withpractice-nurse-a/ (watch only “Encounter with Practice Nurse A” video) ➢Encounter with Dr. Walker. Watch Video 5: Eileen’s encounter with GP (2:17mins) https://www.wiimali.com.au/eileen-poolesencounter-with-gp/ ➢Eileen then goes to the local pharmacy: ➢Video 6. Watch “Interaction with pharmacist A” video only (2 mins) https://www.wiimali.com.au/eileenpooles-encounter-with-pharmacist-a/ CRICOS code 00025B 4 Biographical approach to health assessment & care planning A biographical approach to health assessment and care planning is a person-centred approach to care that goes beyond assessing and caring for a person's physical and psychological needs to find out more about the older person’s everyday life experiences, their aspirations concerns and relationships and to find out what is important to them. This approach is ongoing and as you come to know the older person through listening to their stories, you gain a better appreciation of their needs and what you can do to assist in their well-being. CRICOS code 00025B 5 Group questions – Practice nurse 1) Did the Practice Nurse demonstrate person-centred care and any aspects of the Biographical Approach to assessment? Describe and discuss examples of person-centred care/biographical approach, demonstrated by the practice nurse, and examples of what was not person-centred care in this client/nurse interaction. 2) Describe and discuss why do you think the patient didn’t ask any questions of the Practice Nurse? 3) Did the Practice Nurse elicit all of the relevant information from Mrs Poole? Describe and discuss what information may have not been elicited from Mrs Poole by the practice nurse and why. 4) Reflect on and describe how the Practice Nurse could have created a more comfortable environment for Mrs Poole, improving person-centred care/ biographical approach communication skills that would enable Mrs Poole to share her concerns? Describe and discuss with practical examples. 5) Describe and discuss how poor communication could have implications for medication safety in this scenario? CRICOS code 00025B 6 Dr Walker 1) How effective was the communication between Mrs Poole and the General Practitioner in this interaction? Did you see any aspects of the biographical approach of assessment? (Give reasons/ examples) 2) What are some examples of effective communication in this interaction? 3) What are some examples of ineffective communication in this interaction? 4) What do you think is Mrs Poole’s impression of Dr Walker? How could Dr Walker improve his communication and listening skills. 5) Discuss the transfer of information between the Practice Nurse and the General Practitioner, in what ways was it effective or ineffective. CRICOS code 00025B 7 Pharmacist 1) What verbal and non-verbal behaviours did each person use in this interaction? 2) Did Mrs Poole get her message across to the Pharmacist? Discuss and describe why the Pharmacist did not pick up on Mrs Poole’s concerns. 3) Describe and Discuss Polypharmacy and what risks for polypharmacy are apparent in this case scenario. 4) Identify factors that posed a risk to patient-safe active listening in this situation. 5) Give examples of how the Pharmacist could have improved her person-centred communication skills and used a biographical approach in her interactions with Mrs Poole. How would this have improved the Quality Use of Medications and Medication safety. CRICOS code 00025B 8